Toubal Marine, Allain-Launay Emma, Bruel Alexandra, Sellier-Leclerc Anne-Laure, Dehoux Laurène, Novo Robert, Baudouin Véronique, Bihouee-Roussey Tiphaine, Roussey Gwenaëlle, Porcheret Florence, Bernard Josselin
Childhood Chronic Diseases Department, University Hospital of Nantes, 7 Quai Moncousu, 44093, Nantes, France.
Pediatric Nephrology Rheumatology Dermatology Unit, Lyon University Hospital, Bron, France.
Pediatr Nephrol. 2025 May;40(5):1771-1781. doi: 10.1007/s00467-024-06604-1. Epub 2025 Jan 7.
Severe respiratory complications following kidney transplantation have been reported, yet remain poorly understood in the pediatric population. This study aimed to document respiratory disease in this population.
At annual follow-ups, patients completed a respiratory symptoms questionnaire and underwent pulmonary function tests (PFTs). We defined respiratory disease in children when they had clinical disorders and/or PFT abnormalities.
Among 236 children included, 110 (41%) exhibited respiratory involvement: 59 (53%) had only clinical disorders, 38 (35%) had only PFT abnormalities, and 13 (12%) had both. Of those with PFT abnormalities, 15 (7%) had obstructive impairment, 12 (6%) had restrictive impairment, and 30 (24%) showed decreased lung diffusion capacity for carbon monoxide (DLCO)/transfer coefficient for carbon monoxide (KCO). In the multivariate analysis, being over 3.5 years of age at the time of transplantation was associated with a reduced risk of respiratory involvement (OR 0.30, CI [0.14; 0.63], p = 0.002), such as induction with basiliximab (OR 0.39, CI [0.17; 0.90], p = 0.03). Conversely, history of immune deficiency, male gender, positive PCR for BK virus and diastolic hypertension were associated with an increased risk (OR 5.96, CI [2.15; 16.51], p = 0.0006, OR 1.97, CI [1.03; 3.77], p = 0.04, OR 3.77, CI [1.14; 12.52], p = 0.03 and OR 2.21, CI [1.13; 4.32], p = 0.02, respectively). Bronchial lesions, such as bronchiectasis, were predominantly observed on tomography.
Given the risk of irreversible lung damage, we recommend systematic clinical and functional respiratory monitoring in case of respiratory symptoms, recurrent lower respiratory tract infections, and risk factors in their follow-up.
肾移植后严重的呼吸系统并发症已有报道，但在儿科人群中仍了解甚少。本研究旨在记录该人群中的呼吸系统疾病。
在年度随访中，患者完成一份呼吸道症状问卷并接受肺功能测试（PFT）。当儿童出现临床疾病和/或PFT异常时，我们将其定义为患有呼吸系统疾病。
在纳入的236名儿童中，110名（41%）出现了呼吸系统受累情况：59名（53%）仅有临床疾病，38名（35%）仅有PFT异常，13名（12%）两者皆有。在PFT异常的儿童中，15名（7%）有阻塞性损害，12名（6%）有限制性损害，30名（24%）显示一氧化碳肺弥散量（DLCO）/一氧化碳转运系数（KCO）降低。在多变量分析中，移植时年龄超过3.5岁与呼吸系统受累风险降低相关（比值比[OR]0.30，可信区间[CI][0.14;0.63]，p = 0.002），使用巴利昔单抗诱导治疗也是如此（OR 0.39，CI[0.17;0.90]，p = 0.03）。相反，免疫缺陷病史、男性性别、BK病毒PCR检测呈阳性和舒张期高血压与风险增加相关（分别为OR 5.96，CI[2.15;16.51]，p = 0.0006；OR 1.97，CI[1.03;3.77]，p = 0.04；OR 3.77，CI[1.14;12.52]，p = 0.03；OR 2.21，CI[1.13;4.32]，p = 0.02）。支气管病变，如支气管扩张，主要在断层扫描中观察到。
鉴于存在不可逆肺损伤的风险，我们建议在随访中出现呼吸道症状、复发性下呼吸道感染及危险因素时，进行系统的临床和功能性呼吸监测。
